BILL ANALYSIS
SB 543
Page 1
Date of Hearing: June 30, 2009
ASSEMBLY COMMITTEE ON JUDICIARY
Mike Feuer, Chair
SB 543 (Leno) - As Amended: June 25, 2009
As Proposed to be Amended
SENATE VOTE : 22-12
SUBJECT: Minors: Consent to Mental Health Treatment
KEY ISSUE : IN SPECIFIED SITUATIONS, SHOULD YOUTHS AGES 12-17 IN
NEED OF MENTAL HEALTH TREATMENT OR COUNSELING BE PERMITTED TO
GET THAT HELP WITHOUT PARENTAL CONSENT?
FISCAL EFFECT : As currently in print this bill is keyed
non-fiscal.
SYNOPSIS
This bill allows a youth 12 years or older to seek outpatient
mental health treatment or counseling services if, in the
opinion of the attending professional person, the youth is
mature enough to participate intelligently in the treatment or
counseling. The author believes that this bill is necessary
because parental consent for mental health services can create a
barrier to treatment, especially in prevention and early
intervention programs. The author asserts that this barrier is
especially harmful to certain populations of youth from abusive
or neglectful homes, lesbian, gay, bisexual, and transgender
youth, youth from immigrant families, homeless youth, and youth
whose cultural backgrounds do not condone mental health
services.
The bill is sponsored by the National Association of Social
Workers, California Chapter, Mental Health America of Northern
California, Gay-Straight Alliance Network and Equality
California and supported by groups representing youths and
mental health practitioners. It is opposed by Capitol Resource
Family Impact.
SUMMARY : Expands the rights of minors to receive outpatient
mental health treatment or counseling services. Specifically,
this bill :
SB 543
Page 2
1)Defines "professional person" who can provide mental health
treatment or counseling services to a minor age 12 or over
pursuant to this legislation to include:
a) A designated mental health professional under specified
regulations;
b) A marriage and family therapist, as defined;
c) A licensed educational psychologist, as defined;
d) A credentialed school psychologist, as defined;
e) A clinical psychologist, as defined;
f) A licensed clinical social worker, as defined; and
g) A marriage and family therapist registered intern, as
defined, working under the supervision of a licensed
professional, as defined.
2)Notwithstanding any other provision of law, authorizes a minor
who is 12 years of age or older to consent to outpatient
mental health treatment or counseling, if the minor, in the
opinion of the attending professional person, is mature enough
to participate intelligently in the mental health treatment or
counseling services.
3)Provides that the mental health treatment or counseling
authorized by this bill shall include involvement of the
minor's parent or guardian, unless the professional person who
is treating the minor, after consulting with the minor,
determines that such involvement would be inappropriate.
Requires the professional person to state in the client's
record about the contacts with the parent or guardian or why
such contact is inappropriate.
4)Provides that the minor's parent or guardian is not liable of
payment for the mental health treatment or counseling provided
by this bill, unless the parent or guardian participates in
the treatment or counseling and then only for such services
rendered with that participation.
5)Specifies that this bill does not authorize a minor to receive
convulsive therapy or psychosurgery, as defined, or
psychotropic drugs without the consent of the minor's parent
or guardian.
EXISTING LAW :
SB 543
Page 3
1)Authorizes a minor who is 12 years of age or older to consent
to mental health treatment or counseling, except as specified,
on an outpatient basis, or to residential shelter services, if
the following two conditions are satisfied:
a) The minor, in the opinion of the attending professional
person, is mature enough to participate intelligently in
the outpatient services or residential shelter services.
b) The minor presents a danger of serious physical or
mental harm to himself or herself, or others, without the
treatment, counseling or residential shelter services, or
the minor is an alleged victim of incest or child abuse.
(Family Code Section 6924. Unless otherwise stated, all
further references are to that code.)
2)Requires that a professional person offering residential
shelter services make his or her best efforts to notify the
parent or guardian of the provision of those services. (Id.)
3)Provides that the mental health treatment or counseling of a
minor must include the involvement of the minor's parent or
guardian unless, in the opinion of the professional person who
is treating or counseling the minor, the involvement would be
inappropriate. (Id.)
4)Defines "professional person" who may provide mental health
treatment or counseling to minors. (Id.)
COMMENTS : In 2004, California voters passed Proposition 63, the
Mental Health Services Act (MHSA), which provides increased
funding, personnel, and other resources to support county mental
health programs and monitor progress toward statewide goals for
children, adolescents, adults and families. Community
stakeholder groups consisting of consumers, families and service
organizations identified various barriers to various populations
accessing not only for MHSA programs, but for all mental health
services. The groups identified that, among other things,
requiring parental consent when a youth seeks mental health
counsel or treatment is a barrier to the youth getting needed
assistance. This bill, sponsored by the National Association of
Social Workers, California Chapter, Mental Health America of
Northern California, GSA Network and Equality California, seeks
to address that barrier to needed services.
According to the author, parental consent for mental health
SB 543
Page 4
services can create a barrier, especially in prevention and
early intervention programs where the youth may not be
experiencing serious physical or mental harm. The author
asserts that this barrier is especially harmful to certain
populations of youth from abusive or neglectful homes, lesbian,
gay, bisexual, and transgender youth, youth from immigrant
families, homeless youth, and youth whose cultural backgrounds
do not condone mental health services. The author states that
this bill will help ensure that youth do not have to wait until
their mental health deteriorates, and their safety is
compromised by suicide, substance abuse, or violence to receive
needed services.
Precedent In The Law Allowing Minors To Access Services Without
Parental Consent . Under current law minors are allowed to seek
certain services without the consent of their parents or
guardians. For example, a minor may consent to medical care for
the prevention or treatment of a pregnancy (Section 6925);
treatment of communicable diseases (Section 6926); medical care
relating to rape or sexual assault (Sections 6927-28); and
medical care and counseling relating to the treatment of a drug
or alcohol related problem (Section 6929). Thus, there is
precedent in the law which makes exceptions to the general
requirement that minors must have parental consent when
receiving certain medical treatment or counseling. These
exceptions have generally been made when there is a compelling
public policy rationale for making services and treatments more
accessible to minors, and where the requirement of parental
consent would deter minors from otherwise seeking these
services.
Under existing law, minors age 12-17 may consent to mental
health treatment or counseling without parental involvement in
particular instances. The minor must be mature enough to
participate intelligently in the treatment or counseling, and
present a danger of serious physical or mental harm to self or
others, or be the alleged victim of incest or child abuse. This
exception to the general requirement of parental consent is
fairly narrow in scope.
This bill expands the existing precedent in current law slightly
to allow youth to consent to outpatient mental health treatment
if the attending professional believes the youth is mature
enough to participate intelligently in the services.
Accessibility to mental health treatment or counseling can be
SB 543
Page 5
critical to youth who are struggling with difficult,
emotionally-damaging life circumstances. Early intervention,
evaluation, and counseling can make a crucial difference in the
mental well-being of a minor. It seems at odds with the public
policy of the state to require minors to reach a state of crisis
before allowing them to seek treatment without the consent of
their parents, especially when the parents themselves may be
contributing to the minor's mental distress. Allowing minors
who are mature enough to engage intelligently in treatment and
counseling seems consistent with the other exceptions the
Legislature has already made in statute for minors to seek
services vital to maintaining their health and well-being.
Technical Amendments : In order to ensure that this bill only
applies to outpatient treatment and counseling, the author has
agreed to the following technical amendment:
Family Code Section 5849.10(a)(1) "Mental health treatment or
counseling services" mean the provision of outpatient mental
health treatment or counseling by a professional person, as
defined in paragraph (2).
Youths May Not Consent To Certain Extreme Treatments For Which
Parental Consent Is Desirable . Regardless of the maturity of
the youth, this bill specifically provides that the youth may
not, without the consent of his or her parent or guardian,
receive convulsive therapy (electroshock therapy), psychosurgery
(which has historically included prefrontal lobotomies, but more
recently includes less invasive techniques) or psychotropic
medication (any medication capable of affecting the mind,
emotions, or behavior). This limitation ensures that while
youth are able to receive necessary treatment or services, there
are clear and very reasonable restrictions as to what may be
done in the absence of parental consent.
The Bill Requires Consultation With The Child Before A
Determination Is Made Regarding Parental Involvement In The
Mental Health Treatment . Under current law, the mental health
treatment or counseling of a minor must include involvement of
the minor's parent or guardian unless, in the opinion of the
treating professional, that involvement would be inappropriate.
This bill requires that the professional person, when
considering the appropriateness of the involvement of the
child's parent or guardian, must consult with the youth. This
will help ensure that the professional has the necessary
SB 543
Page 6
information from the youth on which to base the decision. This
bill still favors parental involvement unless the involvement
would be inappropriate. However, by knowing that the
professional must consult with them before seeking parental
involvement, this bill should help more youth be comfortable
seeking needed mental health services. This bill also provides,
like existing law, that a parent or guardian is not liable for
any costs of the treatment or counseling, except to the extent
that the parent or guardian participates in the treatment or
counseling.
ARGUMENTS IN SUPPORT : Supporters, including California
Association of Marriage and Family Therapists, California
Primary Care Association, Children's Law Center of Los Angeles
and Mental Health Association in California, argue that this
bill is necessary to increase access to mental health treatment
for youth, particularly for prevention and early intervention
services, which in turn will reduce the risk of suicide and
other injurious behaviors for this group.
ARGUMENTS IN OPPOSITION : In opposition, Capitol Resource Family
Impact (CRFI) writes that the bill "will push parents farther
away from knowing about the mental health needs and the physical
locations of their children." CRFI believes that the bill
undermines parental rights and "begs the question: why should
medical professionals have the authority to decide whether
parents can know about the fundamental health condition or
location of their children. Providing for the mental and
physical wellbeing of children is one of the parent's most basic
responsibilities - and in most cases, fulfilling those needs is
among the greatest desires that any parent can experience."
REGISTERED SUPPORT / OPPOSITION :
Support
Equality California (co-sponsor)
Gay-Straight Alliance Network (co-sponsor)
Mental Health America of Northern California (co-sponsor)
National Association of Social Workers, California Chapter
(co-sponsor)
Asian & Pacific Islander American Health Forum
California Adolescent Health Collaborative
California Association of Marriage and Family Therapists
California Primary Care Association
SB 543
Page 7
California Society for Clinical Social Work
California Youth Empowerment Network
Children's Law Center of Los Angeles
Mental Health Association in California
National Alliance on Mental Health
Betty Yee, Chairwoman, State Board of Equalization
Numerous individuals
Opposition
Capitol Resource Family Impact
Analysis Prepared by : Leora Gershenzon / JUD. / (916)
319-2334